Chronic venous insufficiency

Last Updated: 2020-08-17

Author(s): Anzengruber, Navarini

Chronic venous insufficiency, chronic venous insufficiency, CVI, varicose veins, varicosis.

Edema formation and irreversible changes in veins, surrounding tissues and muscle fascia due to chronical recirculation of venous blood.

  • Women > Men.
  • Prevalence: 15-50% depending on source.

Classification by Widmer

Clinical features

Stage I

Edema, corona phlebectatica paraplantaris

Stage II

Stage I &

  • Purpura jaune d'ocre (stage IIa)
  • Hypodermitis & Dermatolipofasciosclerosis Stage IIb)

Stage III

Stage I + II &

  • Scars after healed venous ulcer

Stage IIIa

Stage I + II &

  • Venous leg ulcer

 

Classification according to CEAP (clinical, etiologic, anatomical, pathophysiological)

Level         

 Characteristics
C0 No visible signs
C1 Spider veins, telangiectasias or reticular veins
C2 Varices
C3 Varicosis with edema
C4

Varicosis with trophic skin changes

  • Pigmentation
  • Stasis dermatitis
  • Lipodermatosclerosis
C5 C4 + healed ulcer
C6 C4 + florid ulcer
  • Insufficiency of superficial, deep or transfascial veins.
  • Formation is possible within the scope of:
    • Primary varicoses
    • Secondary varicoses
    • Phlebothromboses
    • A post-thrombotic syndrome
  • Due to the hydrostatic pressure, the test should always be performed standing up.
  • Purpura jaune d'ocre: Due to the increased hydrostatic pressure, erythrocyte extravasation occurs with consequent hemosiderin deposition, which leads to hyperpigmentation on the lower legs.
  • Hypodermitis: Aseptic, acute inflammation of the cutaneous subcutaneous tissue. It is often painful and occurs with redness and tension (pseudoerysipelas). In the course of transition to dermatoliposclerosis.
  • Dermatoliposclerosis: The proteins released in the course of hydrostatic pressure lead to increased cutaneous and subcutaneous collagen synthesis and fibroblast stimulation.
  • Atrophy blanche/capillaritis alba: Porcelain-coloured skin atrophy in the area of the ankles or around an ulcer, which heals in a scar-like manner. There is an increased risk of ulceration.
  • Clinical features
  • Phlebological examination
  • Stage C2-C6:
    • Compression treatment
    • Pütter technique
    • Compression stockings
      • Stage C2: Class II
      • Stage C3-C6: Class III.

 

  • Stage C5-C6:
    • Stage-specific ulcer therapy
    • Compression therapy

 

  • Exclusion of deep leg vein thrombosis.

  • For valve insufficiencies:

    • Vein sclerotherapy
    • Vein surgery

 

  • Topical Therapy
    • Moisturization
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